July 13, 2003
If you don't know someone with multiple sclerosis now, you will. Multiple sclerosis is a disease that damages the central nervous system (brain, eyes and spinal cord) with scattered areas of inflammation as if they had been peppered by grapeshot.
People age 20 to 40, more often women than men, are stricken with the disease.
Early indications often are blurring vision (optic neuritis), a tremor, staggering gait, spasm, muscle stiffness or paralysis, slurred speech, bladder difficulty, or variable limb paralysis. And, the victim often suffers from fatigue. Because the disease lasts 30 or more years, the elderly are frequently affected.
This disease appears to be more common in warm climates, suggesting an environmental factor. Blood relatives of those who have MS develop the disease eight times more often than the general population. Individuals with MS also tend to come from the higher socioeconomic group.
Multiple sclerosis is usually most active in the first four years after its onset. A second attack, however, may occur 10 years later or never. If recovery is complete with each episode, 80 percent have unrestricted function in 10 years. If recurrences are on a background of stepwise deterioration, in 10 years 50 percent are disabled.
The reason for symptoms in MS is a series of defects, called plaques, in the covering (called myelin) of nerve fibers in the brain, spinal cord and eye. Integrity of the myelin is important for rapid transmission of signals. With loss or damage to myelin, signal transport slows and may stop, even though the nerve fiber may be normal otherwise.
Myelin is produced by cells called oligodendrocytes, which are probably the target of the disease, causing loss of myelin. Symptoms may occur when the damaging process is active and may clear as the activity subsides. Multiple areas of scarring (sclerosis) as attacks heal give the name multiple sclerosis.
This process is not much different than the fraying of a lamp cord and the uncertainty that occurs when the light is turned on. Sometimes the electricity flows and there is no problem. At other times the electricity does not flow and no connection is made. When that occurs in MS there is weakness or no movement by the end product of the electrical current.
Exercising muscles and putting them through their full range of movement is important. Muscle spasms can be relieved with medication. Anti-inflammatory steroids by mouth have been helpful. Intravenous steroids hasten recovery, but none of these medicines reduce long-term disease activity. Some anti-cancer drugs are also used to treat the disorder.
Education and group therapy for the patient and their family are very important. Treatments improve the quality of life.
Assessment of new treatment is difficult because of patient and doctor bias and variability of the disease. Trials have to be large, randomized, and include placebo comparison. This tedious, expensive method, strengthened by evidence from quantitative MRI, is yielding some answers.
New drugs are significantly reducing the accumulation of MRI-detected
lesions. Although there is still no cure, we are at last moving in the
right direction to improve the quality of life of those individuals struck
in the prime of their lives. Research continues.
Copyright © 2003, Charlotte Observer